A comparative analysis of acitretin and methotrexate in the treatment of lichen planus

Background and Design: Lichen planus (LP) is a common inflammatory dermatosis affecting people of all ages. Acitretin is one of the firstline systemic treatments; however, certain circumstances limit its use and encourage the search for alternative therapies. We aimed to compare the efficacy and safety of methotrexate as an alternative to acitretin. Materials and Methods: This study retrospectively evaluated the treatment response, clinical characteristics, and demographic features of patients who received methotrexate or acitretin for LP between January 2021-2024. Patients who showed clinical improvement and required continued treatment to maintain control were classified as 'clinical responders'. Patients who demonstrated a clinical response and remained clear after treatment discontinuation were classified as in 'remission'. Patients whose symptoms did not improve with treatment or who continued to develop new lesions were considered 'non-responders'. Results: The study included 66 patients. The mean age of the patients was 53.4+-9.6; 47 (71.2%) were female, and 16 (28.8%) were male. Thirty-one (46.9%) patients took methotrexate, and 35 (53.1%) took acitretin. The clinical response rate in patients receiving methotrexate (n=30; 96.7%) was significantly higher than in patients taking acitretin (n=28; 80%) (p<0.05). The predicted treatment response duration did not differ significantly (p>0.05) between the group taking methotrexate (15.9 weeks) and the group taking acitretin (13.8 weeks). There was no statistically significant difference in the number and duration of patients achieving remission and the side effect rate of the treatments (p>0.05). Conclusion: Methotrexate and acitretin are effective and safe options in LP treatment. Multicenter randomized controlled trials are needed to develop treatment guidelines.